Gas and bloating are some of the most common gastrointestinal complaints I hear in my office.  There are a number of reasons we experience this uncomfortable and sometimes embarrassing symptom.  If you are experiencing gas and/or bloating on a regular basis, it is definitely worth some investigation. There are some underlying causes that need to be ruled out to prevent any potential damage, nutrient deficiencies, chronic disease, and autoimmune conditions.   Listed below are the most common causes of abdominal bloating. 

1. Low stomach acid: Hypochlorhydria is the name given to a condition in which the stomach acid is not sufficient enough to fully break down food and stimulate the release of pancreatic enzymes.  Symptoms of hypochlorhydria include fullness after small meals, heartburn, reflux, bloating and gas.

2. Pancreatic insufficiency: the body requires adequate pancreatic enzymes (and hydrochloric acid in the stomach) in order to break down food into absorbable nutrients.  Low levels of digestive enzymes can be caused by many factors including, the use of antibiotics or other medications, food intolerances, stress, infection, high carbohydrate/sugar diets, and excessive alcohol consumption. When digestive enzymes are low, undigested fats, carbohydrates, and proteins move to the bowel where they begin to ferment causing irritation, inflammation and bloating.

3. Food intolerance: intolerance means the body has difficulty processing and absorbing a particular molecule due to lack of specific enzymes such as lactase in lactose intolerance.  Food intolerances typically do not cause an immune response by the body but exposure to the food can lead to inflammation and abdominal discomfort.  The most common intolerances are to lactose, gluten, and fructose (as in high fructose corn syrup and fruit).

4. Food sensitivity: sensitivities are an immune response against a particular food. These responses are often delayed (up to 72 hours) making it difficult to link the food to the symptoms.  They tend to develop as we age and are thought to be due to weakened gastrointestinal function. Function is weakened by any of the 10 causes of bloating listed here as well as stress, overeating a particular food, genetics and environmental exposures.  Food sensitivities are often able to be corrected with the four R’s (removal, repair, replenish, reintroduce).

5. Dysbiosis including candida/fungal overgrowth: most commonly caused by the use of antibiotics or poor digestion, ie low stomach acid.  Fortunately, there is testing to help determine which organisms are outcompeting the natural flora and causing problems.  Treatment can be tailored toward eliminating problem causing bugs and re-establishing healthy bacteria in the GI tract.

6. Small Bowel Intestinal Overgrowth (SIBO):  is exactly what the name implies.  It is the overgrowth of natural bacterial flora in the small bowel. The cause of this condition is often associated with slow transit time and stasis (opiate use), decreased gastric and pancreatic secretions, the use of proton pump inhibitors (acid blockers), and underlying gastrointestinal conditions such as celiac disease.  SIBO can lead to a number of digestive complaints and symptoms associated with irritable bowel syndrome (IBS).  Bacterial overgrowth impairs digestion and absorption and produces excessive quantities of hydrogen or methane gas.  The gases are a product of carbohydrate fermentation by intestinal bacteria.  Testing is based on measurement of these two gases by breath testing.  There are many diseases associated with SIBO including hypothyroid, lactose intolerance, Crohn disease, diabetes with autonomic neuropathy, fibromyalgia, interstitial cystitis, restless leg, and rosacea, just to name a few.

7. Intestinal bowel disease: Crohn disease and ulcerative colitis could also cause mild to significant gastrointestinal discomfort due to the underlying nature of the conditions.  In both cases there is often substantial amounts of inflammation, leading to gas/bloating, water retention, diarrhea or constipation.  IBD is treatable and is best caught early to prevent any longterm damage to the GI tract or nutrient deficiencies.

8. Motility disorders: Decreased motility by the migrating motor complex can be caused by conditions such as diabetes, scleroderma, certain medications, and pseudo-obstruction.  You can test your transit time by eating a food such as beets or corn and count the number of hours it takes to end up at the other end.  Healthy transit times are between 12-18 hours.  Anything less than 12 or longer than 30 should be cause for further investigation.

9. Poor food hygiene: This is a common problem in today’s world of deadlines and multi-tasking.  We are no longer cooking the majority of our meals or taking the time to rest and digest.  Food hygiene is a vital part of digestive health.  Proper food hygiene includes everything from cooking meals (using whole foods) to eating in a relaxed, screen-free environment.  Smelling the aromas of cooked food triggers gastric secretions and primes the GI tract for digestion, which is key to absorbing the nutrients from the meal.  Meals should not be consumed under stress, feelings of negative emotion, or while hurried.  Try telling that to any mom with young children, and they may never eat!   Proper food combining should also be considered which is a whole different blog post in itself.

10. Hormonal imbalances: Many women experience bloating when there is a fluctuation in hormone levels such as during the menstrual cycle, throughout pregnancy, or during perimenopause.

It’s very common for women to experience more gas and bloating as they go through menopause. Women often become intolerant to foods they’ve eaten all their lives, particularly wheat and gluten. Cutting out these foods can drastically improve symptoms of gas/ bloating and indigestion for many women.  Also, it is common for the production of stomach acid to decline as you age.  Taking a digestive enzyme can help aid in the breakdown and absorption the nutrients.

For more information about any of these conditions or testing, you can contact Dr. Schulz via email at info@integrativemedpdx.com, phone 971.302.3214, or directly through the website at www.integrativemedpdx.com.